I have a tendency to move my decisions from nice, logical decision trees into an underground network of convoluted root balls. Aboveground, choices are determined based on simple, bifurcating factors. Underground, no such rules exist.
Sometimes my decision root balls are so confusing that they’re also wrapped up in other trees’ roots. Those aren’t even my trees! When this happens, it feels like there’s just so much to think about that I can’t consider all of it at once. I’m left with a horribly overwhelming feeling that makes me want to say “no” to everything. It’s like going a million miles an hour and coming to a sudden stop, somehow at the same time.
I’m a habitual overthinker. I feel compelled to organize all possible plans and outcomes before even considering making a choice. The anxiety stems from the powerful feeling that I have to make the “right” decision, or else. The “or else” is vague and in most cases, probably entirely fictional.
And yet, often, I don’t have a specific worst-case scenario in mind. It’s just a sudden feeling of doom. Once I get myself to slow down and think through the choice in actual words, the real overthinking happens. The pros and cons of each choice are easier to hold onto, but they go straight into the center of a decision root ball. Then they get tumbled around for a while before I get frustrated enough to make the decision.
Untangling a Decision Root Ball
I’m learning that, for slightly longer-term choices, I do better when I force myself to not try to make a decision right away, but to instead let it sit for a day or two so as to avoid my immediate reaction. Of course, I can’t always stop myself from thinking about it all the time and being anxious, but I can reduce the pressure a little.
When I succeed at this strategy for overthinking, I’m much better at choosing the option that’s scary but leads to more growth. The positives start to outweigh the anxiety. The decision root ball starts to become a little less constricted.
For shorter-term decisions, I’ve found that I have to do the opposite of the long-term strategy. If I let myself waffle too much, I become paralyzed and am overwhelmingly likely to pick whichever option involves the least uncertainty.
To illustrate this with a mundane example, imagine me considering the benefits and drawbacks of various food court establishments. If I’m overwhelmed by attempting to balance the benefits and drawbacks, I will pick the option with the least uncertainty and go home empty-handed. And by benefits and drawbacks, I mean things like the length of the line, how harried the employees look, the likelihood that I’ll have to shout to be heard, and how chaotic the space around the line is. I mean, seriously. Sometimes, I’m deterred by not knowing what sizing system they use for their cups. It’s a wonder I can function at all.
Maybe someday I’ll progress to making decisions on the spot with minimal anxiety, but that sounds like an expert-level endeavor. For now, I’ll stick to gradually pruning my decision root balls and trying to say “yes” to some things.
Having anxiety about therapy doesn’t mean that therapy isn’t “for” you or that you can’t benefit from it. Instead, it might be a fear you can change by adjusting the way you approach your sessions.
We often focus on the role of the therapist and how well we connect with them when talking about how to feel comfortable opening up in therapy, but we don’t often examine our expectations of ourselves. Self-criticism and high expectations had me feeling anxious about therapy until I changed the way I thought about myself as a client.
When I decided to start going to therapy in college, I was apprehensive about having to do the classic back-and-forth discussion with my chosen therapist. In fact, I’m still not always keen on it. But the expectation that I held for myself – that I would sit down and spill my guts and cry and reach some kind of catharsis every week – did not pan out. The more accurate picture was (and sometimes still is) one of me sitting down, saying I’m okay, shrugging a lot, and forcing my therapist to sit in silence with me while I wrestle with my thoughts.
I thought for a long time that I was bad at therapy. I was very critical of myself for inadvertently shutting down. Sometimes, I still feel guilty because I perceive my excruciating quietness as a waste of my therapist’s time.
Shifting My Perspective on Myself in Therapy
The longer I’ve stuck with it, the more I can see that this perspective of myself as something like a student who is expected to achieve success is preventing me from recognizing the progress I’ve made. As a perfectionist, I’m prone to thinking that no amount of improvement is good enough, and if I’m not meeting my own expectations, I must be failing. Perhaps even more importantly, my anxiety about therapy gets in the way of me focusing on what I can get out of the process despite and because of my difficulty with certain topics.
I have been trying to shift my perspective on my role in therapy to be more like that of an explorer or some kind of self-ethnographer. I go to therapy, I do my best to talk, and I observe whatever happens. I’m there to be curious, and if talking about something is suddenly challenging, that in itself is interesting information.
Why Go to Therapy if It’s So Uncomfortable?
I learned early on in my experience with therapy that although talking about myself is deeply uncomfortable, it feels worthwhile. I have always been quiet and reserved, and I tell myself that it’s a preference. But, finding myself unable to answer personal questions in therapy taught me that I have less control over it than I wanted to believe.
To Challenge Myself
When pushed to discuss something I’m uncomfortable talking about, I simply clam up. It frustrates me because it does not feel like a voluntary reaction. Obviously, I go to therapy to talk about myself – why can’t I override my tendency to shut down? It’s like a drawbridge lifts in front of me, and I can no longer get my words across the gulf between myself and my therapist.
To Practice Being Vulnerable
Ultimately, therapy led me to the realization that while staying quiet is comfortable for me, it is also lonely. I don’t intend to change my natural tendency to be reserved, but I do hope that by practicing being open about difficult things, I can allow my reservation to be a choice, not a barrier.
Everyone has secrets, and it’s perfectly okay to keep them private. But there are times when it’s good to share personal information, especially if it’s going to help you overcome a challenge in your life. Holding secrets out of an inability to put them down can be a deeply isolating experience.
Finding Ways Around My Anxiety About Therapy
I’ve gotten better at talking about myself in therapy, but it’s still hard. I still have sessions where I can’t seem to find the lever to lower the drawbridge and let the words out, and that’s okay. My therapist knows that I stay quiet not out of disinterest in the process but because it’s hard for me to engage in it.
On days when I don’t say much, I go home and write her an email with all of the words I couldn’t set free. It gives us somewhere to start the next time and lets me communicate in a way that’s easier for me. I still challenge myself to talk, but I know that I have a backup line of communication if I need it.
Whether I choose to discuss something or not is up to me, of course. My therapist is there to guide me, even push me a little, but ultimately, I decide what to talk about or not. If I want to set aside a more difficult subject in favor of discussing something easier but still meaningful, I can do that.
Considering the Therapeutic Relationship
I have found that for me, viewing a therapist’s role as that of a knowledgeable partner rather than an authority figure helps me stay intrinsically motivated and makes me more willing to push myself. We’re exploring my brain together, and I know that if I don’t accomplish something I set out to do, I won’t be “in trouble” with my therapist the way I would think I were if our relationship were less equal.
It’s a strange relationship to navigate — one that is inherently unequal in more than one way. You go to a therapist for help because they have knowledge and a perspective you don’t. You pay them, and you probably defer to their expertise. They are in a position to set expectations and try to interpret the implications of what you say or don’t say. It’s easy to start seeing your therapist as someone to impress, especially if, like me, you’re a chronic people-pleaser.
At the same time, clients have the option to stop going, the freedom to ask for adjustments in their treatment, and the potential to view themselves as indispensable experts on their own experiences. It can be motivating to think of therapy as something you get to take part in with your therapist rather than something you have to go to. Ultimately, I think the dynamic of a partnership makes me less likely to fear that my therapist might disapprove of or be disappointed in me for not achieving something or even for not talking enough.
I’m still trying to let go of my self-imposed pressure to be a wonderfully verbose client. I go to therapy to work on my depression and anxiety, and part of that involves being less critical of myself. I used to think I was a bad client because of my anxiety about therapy. Now, I think I struggle to talk about myself, and that’s part of why I’m in therapy.
The first time I experienced shame related to mental illness, I was 11 years old and caught in the torturous intrusive thoughts and compulsive behaviors of OCD. Therapy did not go well because I found it nearly impossible to overcome my shame and embarrassment enough to participate. There were times when I was so appalled at myself for having intrusive thoughts that I genuinely feared my parents might stop loving me if they knew what I was struggling with.
The shame about mental illness started early, and the shame about taking psychiatric medication soon followed. Therapy was not going to work, so when I was 13, I agreed to start taking Zoloft. I remember leaving my psychiatrist’s office with my mom after that appointment and just sobbing in the middle of the parking lot. I felt so broken in such horrifying ways, and I thought that taking the medicine meant I was failing to fix myself.
Where My Pill Shame About Psych Meds Started
It felt like a very adult thing, taking medication. I’d carefully dole the pills out into their respective days in my weekly organizer. When I took them, I’d count them over and over and over – One, two. One, two. One, two. Sometimes, I would ask my mom, “Is this two?” and point to the pills in my palm. The root of that counting compulsion was the fear that I might accidentally take more than I was supposed to and overdose. OCD had such a hold on me that I doubted my ability to count to two.
Zoloft completely changed my life. Once I reached 200 mg, it was like my brain had been rebooted and all the bugs were gone. It was amazing. I took it for a few years and then came off it. Although I slip into old patterns sometimes, the OCD never returned in anywhere near full force.
Self-Criticism about Depression Medication in Adulthood
As an adult with treatment-resistant depression, I have mixed feelings about psychiatric medication. The Zoloft helped when I was a kid, but it was still something I considered to be shameful – something to be hidden. Whether that pill shame stems more from my own insecurities, my family’s attitudes, or societal messages, who’s to say? All I know is that I’ve never been able to shake that feeling, despite years of therapy and much contemplation on the irrationality of my beliefs.
I’m always hesitant to write about this. I want to emphasize that I know the way I think about psychiatric medication is unhealthy, and I don’t think anyone else should feel the way I do. It’s odd that being aware of that doesn’t seem to change my thoughts about myself. So, I guess this is a “don’t do what I do, but if you do, you’re not the only one” kind of a post.
Sometimes, I accept that taking psychiatric medication for my depression is the right choice for me. It keeps me safe-ish and mostly functioning, so I try to appreciate the benefits and set aside my gripes on the subject. When my depression worsens, though, all of that goes out the window. I start thinking that I’m lazy and selfish and a horrible burden on my loved ones. Much like when I was younger, I tend to view my psych meds as daily reminders of my inability to fix myself through force of will.
Psych meds help me attain the activation energy needed to use healthy coping skills, but I also know that making behavioral changes can improve depression on its own. In my brain, if I’m not “better” yet, I must be doing therapy wrong or not trying hard enough to implement new practices.
But, Do I Need Psychiatric Medication?
I’m so tied to ideas of independence and self-sufficiency that benefiting from my depression medication feels wrong. It almost feels like cheating. I tend to think that if I make progress while taking meds, I didn’t really earn it.
Whenever I try to change the medications I take and my depression gets worse, it seems like proof that the work I was doing to help myself wasn’t enough to even make an impact. If a change in my medication sends me tumbling back down the mountain, was I supporting myself at all with other strategies? It’s a discouraging thought that leaves me teetering between believing that I need to try harder and nothing I do will make a difference.
You would think that the solution to that would just be to stay on my meds, but my mind is a convoluted mess, so it’s not that simple.
Is the Improvement from Psychiatric Medication Real?
I try to remember that during the times when my depression has been much better, I don’t feel so strongly about how medication helped me get there. That suggests that I’m not seeing things clearly when I’m depressed.
Then again, maybe I don’t care about it when I’m better because the medication is influencing me in such a way that I forget about the beliefs I held before. Maybe I’m seeing the truth about myself and the pointlessness of life more clearly when I’m depressed, and that perspective is covered up by my medication when I’m feeling better. I know that sounds wild, but sometimes I’m moderately convinced by this weird logic.
Self-Compassion and Treatment-Resistant Depression
I’ve spent years trying to learn how to be kind to myself and accept that my mental illness is not my fault. I know that I’ve made progress, but sometimes, it just falls apart. It’s like I’m climbing a flimsy ladder, and every once in a while, I slip and go crashing through the rungs below me. And then I’m in an undignified heap on the ground, berating myself for not accomplishing my goals and using medication when I shouldn’t need to.
I don’t give myself any space to accept that there’s something not right in my brain, and it’s okay if I can’t fix it by myself. I know this cognitively, and yet I can never seem to fully convince myself of its validity.
Do you relate to any of what I wrote in this post? Do you see your medication differently? I’d love to know.
My therapist has been encouraging me to track my depression and various contributing factors for years. I’ve tried several apps, journals, and charts, but I always drop the practice after a little while. Eventually, I identified why those tools never worked for me and used that information to make my own system.
Why Motivational Journals and Apps Don’t Work for Me
I understand why a system with lots of elements appeals to some people, but I tend to find them discouraging – the opposite of their intended effect.
My Depression vs. Positivity
Whenever I tried an inspirational/motivational journal, I quickly lost interest. I’d open it up to mark down that I felt like a person-shaped vat of cold, unsalted mashed potatoes. The list of weekly goals I hadn’t met would be staring up at me. Some inspirational quotes would arrive in my brain through the filter of my depression, limp and meaningless. Over time, I began to avoid them, knowing that the initial excitement of setting up a shiny new tracking system would sour.
Apps Aren’t It, Either
Apps have the advantage of offering daily reminders, but if the app is structured like the previously discussed journals, a cheery notification that it’s time to check in only distances me further. I really wanted apps to work for me, and I’ve been consistent with them for two or three weeks at a time, but I always abandon them eventually. They’re too complex, they ask me too many questions, or they document more than what I want to track.
Mood Scales and My Problem with Numbers
Number-based tracking scales usually include too much choice for me and don’t allow for flexible indecisiveness. A 1-to-5 scale just paralyzes me. What if I say “3,” but I’m really a “2?” That would be catastrophic, obviously.
Maybe it’s a vestige of perfectionistic test anxiety, like I have to choose the “right” answer and be consistent in my interpretation of the scale or else anyone who looks at my data will get an inaccurate sense of my mental health. So instead, I just stop using them. When there’s no data to look at, I didn’t do it wrong!
So in the end, I decided to go with what my therapist suggested in the first place (I must be exasperating when it comes to tracking), and just made my own system to track my mental health.
My Method for Tracking Mental Health Symptoms
I wanted something straightforward, easy to use, and without the frills of a motivational journal. I got a completely blank, unruled journal and a set of stencils. I found these stencils online by searching something like “bullet journal stencils.”
The Mood Tracker
Each hexagon represents a day, which I’ve drawn a line through to depict AM on the top and PM on the bottom. I chose three colors to be “good,” “blah,” and “bad.” This way, I only need to pick a color and fill in the shape. If I can’t decide on a color, I can mix two of them together or shade the shape according to how the day progressed.
I also write small notes every now and then for medication changes, ketamine appointments, and other factors. I like that the bare minimum for this system feels doable for me but isn’t so scant that it’s uninformative.
The Medication Tracker
The medication tracker is similar to the mood tracker in that each section represents a day of a month. The inner row is morning and the outer circle is night. I picked a color for “Yes, I took my meds” and a color for “No, I didn’t take them.” It does help me to see how frequently I’ve missed doses, partly because the perfectionist in me hates to see too much orange.
I keep the journal and the colored pencils in my nightstand so they’re easy to get to and I don’t have the excuse of already being in bed when I remember to track.
How It’s Going
I’ve been consistent with this method for a little over two months, which is probably the longest stretch I’ve ever gone with tracking mental health symptoms. I can’t say that anything groundbreaking has come of it yet, but it is interesting to confirm some of my expectations.
I’ve tried and abandoned so many methods that I don’t think I showed my therapist my journal until I had been using it for a month. I didn’t want it to be yet another dud in a long line of tracking tools. So, I kept it to myself for a little while and am only just starting to assess its usefulness.
Just like with any mental health-tracking method, there are gaps in the data that become evident over time. I’ve been adding symbols to my mood tracker for things like self harm and my period. It’s becoming more complex, but I think the fact that I decide when to add those symbols rather than having a dedicated section for them works well for me.
That said, I’m considering adding a way to track more factors, such as appetite, sleep, and exercise. I don’t want to make it too complex, but I might have the habit established enough to expand my system without abandoning it.
There are tons of ways to track mental health symptoms and factors, and you can find many of them detailed online. What way works best for you?
My depression has not been great lately, and I’ve let my blog go wild in my absence. The longer I go without posting, the harder it is to pick up again. I have to think back to where I left off and decide how to begin.
After the Disaster
Last I wrote, I was wrestling with the loss of our house and belongings after a grassfire destroyed them. Life has gone on, as it tends to do. I’ve been back to the house a few more times, but only to look at it – not to search for anything. Yesterday, I parked by the trails near my neighborhood (when do I start calling it “my old neighborhood?”) and got out to look at the mesa. Green grass was growing like stubble over the burned landscape. I don’t know why I was surprised to see it that way. I knew the mesa would recover quickly. I suppose it was just more painful than I expected to notice the passage of time after a disaster.
It’s not prominent in national news anymore, displaced people have scattered and settled, and we’ve acquired all the things we need in our new place. The wider community is moving on, as is reasonable and expected. And yet, it still feels so immediate and all-encompassing to me.
The Day-to-Day Stress
Wind, for instance, makes me feel a horrible sense of dread. It reminds me of walking Stella by the houses across the street that morning, several hours before the fire. Snapshots of it come back to me: a woman in her pajamas, rushing to pick up trash from her capsized bin; a full recycling can skidding across the street at high velocity; picking up crumpled, Christmas-themed debris and hearing someone remind me that wrapping paper can’t be recycled.
Most viscerally, though, wind reminds me of stumbling to a fencepost on the mesa, my hair whipping around my face in the deafening howl of near hurricane-force wind. It reminds me of standing there in disbelief, watching the wall of smoke move closer.
I was driving during a high wind advisory the other day, and all I could think about was my dog, Stella, alone in the apartment. I wanted to get back there as soon as possible in case a fire broke out. I couldn’t help but imagine the terrible possibilities. What if the road to the gate was clogged with cars? Could I park on the sidewalk and climb the fence? How would I transport Stella and our things to the car? What would I take? I imagined myself climbing the fence and running to our apartment, only to realize that imaginary me had left the garage door opener in the car, and I would need it to get inside. Should I break a window or run back to the car?
Suddenly, my GPS told me to get off at the next exit, so I took a deep breath and reminded myself that it was windy. That was it. No emergency.
The slightest thing will make me think of the fire. A wooden bowl in a craft store brought me to tears the other day. The realization that it’s spring and I don’t have any warm-weather clothes is disheartening. Then again, I don’t think about it all the time, and in some ways, I’m settling into our new place and getting used to my new routine. When I try to notice when things don’t suck, I can identify things about the apartment that I like. It’s sunny, conveniently located, and it has walking paths nearby. I like my room, which feels bigger than my old one. My new plants are doing well. It’s a nice place to live, and we’re fortunate to have it.
Depression is Stubborn
Despite the positive developments, my mental health has been declining for a while. Well, it’s on a low plateau, like one of those deep-sea shelves. Even before the fire, things were trending downward, so all the upheaval hasn’t helped my depression.
I’m having a hard time pulling myself out of the hopelessness. Whenever my depression worsens, I struggle to see things positively, and not just about the fire. The future is hard to imagine. Depression seems to stretch on infinitely. I can go out and do things and even enjoy them on some level, but underneath the top layers, any kind of meaningful goal or long-term ambition feels like too much effort and utterly out of reach.
Depending on when I finish working for the day, I either take a nap or go for a walk with Stella. My afternoon walks feel long and exhausting, but Stella doesn’t mind if I walk slowly and stop a lot. I let her point us down a new street the other day, and I ended up getting completely turned around. I had to use Google Maps to get back. Small hiccups like that make me irritable when my mental health is poor, so I put Stella on a short leash for the rest of the walk. She eats goose poop, rolls on damp dirt, and forgets she’s on a leash when she takes off in pursuit of squirrels. It’s better if she walks right next to me.
I know that I’m very isolated. It’s somehow overwhelming to talk to friends or even make a blog post. I worry that if I go do something social, I’ll run out of energy and won’t be able to muster up any enthusiasm. Usually, it’s fine, but the thought of it is so exhausting that I’d rather be alone. I’m more comfortable alone, but I know it’s not good for me.
I don’t like abandoning my blog for long periods of time. Depressed me struggles to create an entire post that follows a cohesive story or structure. When I do write something, I usually convince myself that it needs more work before I can post it. I let it languish in my drafts folder until I eventually return to it, read it, and wonder why I thought it was so bad. This post, for instance, is a conglomeration of several drafts I wrote over the last few weeks.
The combination of depression and perfectionism is a strange mix. When it comes to things like showering and eating, I’m apathetic. But, when I’m writing a blog post, an email, or even a text, I have to edit obsessively. That is, until depression fills me up with apathy like sand in an hourglass, and I decide to set aside my writing.
Let’s see how long it takes me to write the next one. I’m setting that clam for one week. Maybe two.
I recently took my first dose of Stelara, an injectable medication known as a “biologic” that treats, among other things, psoriasis. I’m so excited, I could pop.
What is Psoriasis?
Psoriasis is an extremely visible autoimmune condition which results in red, inflamed skin with scaly white flakes. My immune system is attacking my skin, causing the affected skin cells to turn over at a dramatically accelerated rate (7-10 times faster than healthy skin!) The severity of my psoriasis can be seen not only from the outside, but from the inside as well. My bloodwork shows evidence of systemic inflammation, which puts me at risk of developing other illnesses, including psoriatic arthritis.
Treatment with Topicals
For the past 15 years, I’ve tried to make topical creams, ointments, solutions, and for a while, UV light treatments, work for me. Using topical treatments properly requires that you follow a schedule of twice-a-day application for two weeks on, two weeks off in various combinations of steroids, vitamin D derivatives, and whatever other prescriptions you’ve been given. It takes me about 30-40 minutes each time.
After about a week, I see definite improvement, which used to be incredibly exciting but is now a pointless exercise in bitter disappointment. As soon as I begin the recommended two-week steroid-free period or simply run out of motivation, my skin begins the infuriating cycle all over again, often worse than the last time. I have never had a period of complete remission.
Treatment with Biologics
I reached a tipping point. I don’t know what exactly pushed me over the edge, but I know that I can’t take it anymore. My psoriasis is “severe,” meaning at least 50% of my body’s surface area is affected. Topical treatments aren’t enough, so my dermatologist and I decided that Stelara is the best option for me.
Biologics like Stelara function by suppressing the immune system, which puts you at risk of infections and certain cancers, but the newer biologics are more targeted than older ones. They attempt to treat only the parts of the immune pathways that are going wrong, which reduces the impact on other immune system functions.
Take That, Psoriasis
It makes me anxious to include photos of myself in this post, but I’m tired of trying to navigate the steps I take to hide my skin. Do I dare wear something with an open back? Should I stick to shirts that go up to my neck? Better avoid dark colors so the flakes aren’t obvious.
Psoriasis has been squashing the self-confidence out of me since I was 10 years old. Knowing that I’ll likely deal with psoriasis in one way or another for the rest of my life, I’ve worked to derive my confidence from who I am rather than how I look, but it’s an internal conflict that I’ve never completely solved. I desperately want Stelara to work for me. It’s exhausting to be, on some level, constantly self-conscious. I can’t fully imagine how much of a relief it would be to put that behind me, but I also don’t want to forever be embarrassed about these years of my life. I don’t want psoriasis to win.
This is what I look like, and if you look like this too, know that you don’t have to fit societal standards to be confident in the skin you have.
Living with Psoriasis and Self-Criticism
[In this post, I describe my feelings about life with severe psoriasis. I do not want readers who have skin conditions or any physical differences to be hurt by my self-judgments and insecurities. My words are about my experience only.]
It’s taken me so long to come around to the idea of taking a biologic because I blamed myself for not being more consistent with topical treatments. I thought that if I could just be more diligent, my psoriasis wouldn’t be so bad.
It was like boiling a frog; maybe I could have kept it at bay in the beginning, but it just got worse and worse. Eventually, I was so accustomed to it and so convinced that its severity was my fault that I chose to stay in the scalding water rather than get a lift out on a ladle. I also do this with my mental health; I must not be trying hard enough. If I just keep at it, I won’t need to accept more help. If that sounds completely unreasonable, it is – but it’s hard to change thought patterns like that.
Bottle it Up (don’t, though)
I’m 25 now, and my psoriasis is so severe and I’m so disillusioned when it comes to making a dent with topicals that I only use them “as needed” (in my view of “need”). When just twisting at the waist splits the plaques down to raw, bleeding skin and I can’t stand the torture of having unreachable itches in my ear canals, my motivation is briefly renewed. When it inevitably worsens again and I can’t manage it, I’m hard on myself for letting it happen then and all the times that came before. So in order to deal with despair over what I came to see as a failure to fix myself, I became an expert at avoiding the emotions of it. If I let myself fall apart every time I thought about it, I’d never move. It’s far more comfortable to disconnect.
The reality of living every day in this burning, itching skin is too horrible to acknowledge all the time. Instead, I bottle it up until it explodes. I can go long stretches of time feeling like I genuinely don’t care – as long as I cover it with my curated wardrobe of acceptable garments and don’t have too much psoriasis on my face, I’m really quite good at pushing it out of my mind.
But eventually, it’s like I catch a glimpse of it from a stranger’s perspective and am knocked over by the pure shock of it. It hits me suddenly and I break down into tears and fury and grief over how it holds me back and the hopelessness that it could be forever. I’m suddenly overwhelmed by how disgusting and ugly I feel – judgements that I try to keep beneath the surface, but which sometimes bubble up painfully. Then, I gather myself up, shove it all back down, and tell myself that self-pity is pointless. I basically close the Faulty Logic Door on the Emotional Vault until the next time it explodes. Super healthy.
Prioritizing Experience over Appearance
Despite the harsh messages I send to myself about my appearance, I still want to move through the world unhindered by social stigma. Lately, I’ve been pushing myself to wear clothes that make me a tad anxious and, with the exception of swimming, I never let it stop me from participating in things. I’m always worried that people will be rude or hurtful, but that’s rare and stems from ignorance, not malice. Some people stare at me and I occasionally get well-meaning but unsolicited and questionable advice from strangers, but I’ve found that the vast majority of people don’t even bat an eye.
By virtue of being literally on the face I present to the world, facial psoriasis is particularly hard to deal with. Everyone sees it and has thoughts about it that I’m not privy to. My fears that those thoughts might be judgmental and mean are hard to set aside.
I decided a long time ago that wearing makeup to cover my psoriasis was not worth it. Besides the issues of time, money, and probable skin irritation of heavy-duty foundation and concealer, my desire to fit in and feel confident bumps up against my belief that it shouldn’t matter. It seems like a step too far for me, but for others, it makes a huge difference in their confidence, so, to each their own.
Mild topical steroids and other prescription creams do improve my facial psoriasis considerably, but only for as long as I’m using them, which is sparingly. The skin on your face is delicate, and the decade and a half that I’ve spent using topicals makes me reluctant to risk the side effects of overuse or – God forbid – getting them in my eyes. That’s tricky for me, because I have psoriasis on my eyelids.
On the left is how I wake up during a period of average/low inflammation. With very gentle soap, some careful flake removal, and unscented moisturizer, I can sometimes go from that to the righthand photo without using a prescription cream, which I save for really terrible days. I tend to have wonky, uneven eyelashes because, during bad flares, psoriasis spreads along my lash line and causes sections of eyelashes to fall out.
Interference and Feedback Between Psoriasis and Mental Health
Stress is a common trigger of psoriasis, which is hard to fix because having psoriasis is pretty stressful. As my mental health waxes and wanes, my psoriasis follows suit in an awful feedback loop. The stress of depression makes my psoriasis flare, and the hit to my self-esteem certainly doesn’t do good things for my depression.
My mental health definitely gets in my way when it comes to skincare. Even if I didn’t have depression, I probably wouldn’t be able to keep up with the treatment routine, but when depression makes getting out of bed and changing my clothes difficult, you can bet that I’m not spending an hour and 20 minutes per day applying goop to the skin I hate looking at.
Overwhelm and Support
Depression and psoriasis are both chronic and painful, and they both take a lot of work to manage. Metaphorically, the overwhelmingly hopeless experience of depression feels like trying to beat back a chronic rash that covers your whole body using nothing but a little tube of ointment. Each is a monumental effort that seems to never end. I’ve learned that tackling difficult, stigmatized issues gets a little easier if you don’t do it alone.
Lithium, which treats my depression and suicidal thoughts, has the unfortunate side effect of causing or worsening psoriasis. (Is that a cruel joke, or what?) I’m not sure how much of an impact it’s had, but I suspect it’s contributed somewhat to the progression of my psoriasis.
[Left: After a dedicated effort to clear my skin in time for a wedding in 2018. It was brief but wonderful. Right: A terrible flare in the cursed year that was 2020.]
Any time I spent bullying myself about my skin and my willpower was too long. This change is not a failure, but a success in finally allowing myself to accept help.
Stelara is a momentous step for me; I’ll admit it’s filled with a fair amount of bitterness about how many years I’ve spent suffering, but also acceptance, excitement, and hope.
May is Mental Health Awareness Month! One lesser-tackled mental health topic (in my opinion) is that of periods and mental health.
Invalidation: Public and Self
We often see in media the idea that a woman on her period is “crazy”- invalidating language that means it’s ok for others to ignore her feelings. I think it’s important to recognize that the hormonal changes we experience don’t suddenly make us different people. I, for one, become rather cranky, but not because I’ve developed a new set of preferences and opinions; I just have a lower tolerance for irritation. A much, much lower tolerance. Things that at any other time would simply make me shake my head suddenly either make me briefly, intensely angry or likely to burst into tears.
I find myself downplaying the effects of my period on my mental health all the time. I think it stems from its temporary nature. I know that it won’t last long, so it seems silly to let it take up much space on my list of mental difficulties. When I’m seeing red because somebody put a spoonful of cooked rice in the dishwasher and ran it, I invalidate myself. I tell myself that how I feel doesn’t matter because it’s caused by temporary hormones and my reaction is disproportionately intense. And it is temporary and more intense than is warranted. But the reality is, it’s extremely uncomfortable to experience month after month. Each small instance of unreasonable mood swinging adds up to something with tangible impact.
But it’s ~Natural~
Having a healthy menstrual cycle is a positive thing! If women for millennia have been dealing with theirs, why should I let mine be a roadblock for me? I’m sure women millennia ago thought it sucked just as much as we do, if not more. Modern methods of dealing with it hygienically and the availability of painkillers probably makes menstruating a good deal more comfortable for us. (Of course, there’s a conversation to be had about poverty’s restriction of women’s access to these modern resources. Not everyone enjoys the comforts of disposable period products. Here’s a good resource for learning about period poverty.)
There are definitely positive ways of talking about periods; their position in the menstrual cycle plays a vital role in fertility and reproduction, after all. That doesn’t eliminate the damage that periods can do to our mental health, however. We can recognize the beauty of a natural, cyclical process while also shaking our collective fists at Mother Nature.
PMS and Depression
As many as 3 in 4 women experience PMS. Symptoms include mood swings, irritability, crying spells, social withdrawal, and a host of uncomfortable physical symptoms. That alone is more than enough to be impactful when it comes to a person’s periods and mental health. And what about people who have a mental health diagnosis in addition to PMS? According to the Office on Women’s Health, “Many women seeking treatment for PMS have depression or anxiety. Symptoms of these mental health conditions are similar to symptoms of PMS and may get worse before or during your period.”
Personally, I can say with certainty that when I’m really struggling with my depression, my suicidal thoughts and the urges to self harm are worst leading up to and during my period. In fact, my period started a few days into my hospitalization in 2019 – a connection that I only made later on. The effects of the hormonal changes may be temporary, but my period is a setback to my mental health on a regular basis. And with an extremely serious thing like suicidal ideation, any factor that worsens it is nothing to be dismissed. Sometimes, even when things are getting better, I have sneaky, destructive thoughts because of hormonal fluctuations.
In those cases, it is helpful to remember that my period is to blame and that it will pass. I have to strike a balance, though. It’s easy for me to bully myself into feeling bad about slip ups and setbacks because “it’s just my period.” Hormones are powerful and their effects are very real, no matter how temporary.
Managing Periods and Mental Health
There are many ways to manage PMS for a better relationship between your periods and mental health. Many people find that lifestyle changes through diet, exercise, and healthy sleep are enough to improve their PMS, but your doctor might suggest other options as well. Hormonal contraceptives can help even out the dramatic peaks and valleys of hormone changes. For some people, PMS rises to the level of PMDD, or premenstrual dysphoric disorder. This can be treated through a variety of interventions.
It’s unfortunate that conversations about the mental health effects of the menstrual cycle are reserved only for certain private settings and are kept to a quiet minimum. Periods are a fact of life for many people. We should be able to discuss them openly as a legitimate factor affecting mental health. A survey of 1,500 women found that 58% have been embarrassed about their period at one point or another. 62% of respondents were uncomfortable even using the word “period.” Thankfully, there are many initiatives fighting stigma and working to provide resources to women and girls around the world, and we can keep the conversation going.
How does your period impact your mental health? Have you experienced period shame?